New Congress, New Statehouse Landscape
What the 2026 Elections Mean for Heart Rhythm Advocacy
The 2026 elections are reshaping the landscape for health policy in Washington and across the states. Democrats have won control of the U.S. House and Senate, while state elections have changed legislative majorities, broken supermajorities, and brought new governors and physician policymakers into office.
For Heart Rhythm Advocates (HRA), the task is to translate that changing landscape into opportunities to improve care for patients with heart rhythm disorders. Stable Medicare physician payment, timely access to treatment, fewer unnecessary administrative barriers, a strong workforce, and sudden cardiac arrest prevention remain priorities that require support across party lines.
This assessment is preliminary. Votes are still being counted, several races remain uncalled, and results have not been certified. Congressional and state legislative leadership, committee assignments, and final partisan margins are still taking shape.
A change in congressional control
Today’s (November 5, 2026) results snapshot shows 240 Democratic seats and 147 Republican seats, with 48 races uncalled. The Senate’s incoming Democratic caucus, including two independents, has secured 54 seats to Republicans’ 44, with Alaska and Mississippi unresolved. These are interim results, not final chamber sizes. Mary Peltola (D) in Alaska and Scott Colom (D) in Mississippi have held narrow leads in the reporting reviewed, but neither contest should be counted as an additional Democratic pickup without a race call. Alaska may require ranked-choice tabulation; Mississippi’s outstanding provisional ballots could be decisive.
Democrats flipped seven Republican-held Senate seats: Iowa, Kansas, Maine, North Carolina, Ohio, South Carolina, and Texas. The change will give Democrats control over committee agendas, hearings, and oversight when the next Congress begins in January.
Physician voices: departures and new opportunities
The results also change who will help shape health policy.
Sen. Roger Marshall, MD (R-KS), an obstetrician, lost reelection. HRA has worked with his staff, and his departure removes a physician policymaker who serves on both Senate Finance and the Health, Education, Labor, and Pensions (HELP) Committee. Rep. Mariannette Miller-Meeks, MD (R-IA), an ophthalmologist involved in physician payment policy, also lost her seat. Separately, current HELP Chair Bill Cassidy, MD (R-LA) will leave Congress following his earlier primary defeat.
Incoming physician members include Annie Andrews, MD (D-SC), a pediatrician, and Abdul El-Sayed, MD (D-MI), a physician and epidemiologist, in the Senate. Reported House winners include surgeon Adam Hamawy, MD (D-NJ), neurosurgeon John Cowan, MD (R-GA), and pediatrician Richard Pan, MD (D-CA). Their clinical backgrounds create opportunities to discuss the realities of patient care, although their committee assignments and positions on individual HRA proposals remain to be established.
The departures also include HRA policy champion Rep. Brian Fitzpatrick (R-PA), whom AP reports lost to Democrat Bob Harvie in Pennsylvania’s 1st District. His loss adds to the turnover among returning members and reinforces the importance of building relationships with incoming lawmakers.
HRA-endorsed Roy Cooper’s Senate victory in North Carolina creates another important opportunity for engagement. Rep. Greg Murphy, MD (R-NC), also endorsed by HRA, has declared victory in a close contest, but most news outlets still list his race as unresolved. Physician candidates Reps. Mike Kennedy (R-UT), Scott DesJarlais (R-TN), and Amish Shah (D-AZ) are also awaiting calls.
Returning physician members reported as reelected include John Joyce (R-PA), Raul Ruiz (D-CA), Kim Schrier (D-WA), and Herb Conaway (D-NJ), providing continuity alongside the incoming class. The final size and partisan composition of the physician contingent will depend on the outstanding races.
Committees will shape the path forward
Changes in congressional control will affect the committees responsible for HRA’s agenda:
House Ways and Means: Current ranking member Richard Neal (D-MA) is positioned to seek the chairmanship. Medicare physician payment and Medicare Advantage policy will remain central to HRA’s engagement.
House Energy and Commerce: Frank Pallone (D-NJ) is expected to return as chair, subject to formal selection. He chaired the committee from 2019–2022 and led the HEARTS Act, which became law in 2024. He has also called for payment stability and fair physician compensation and questioned the burdens imposed by the Merit-based Incentive Payment System (MIPS).
Senate Finance and HELP: Ron Wyden (D-OR) and Bernie Sanders (I-VT), respectively, are expected to lead these committees. Their jurisdictions make them essential partners on Medicare, insurer oversight, workforce issues, and FDA legislation, including the next medical device user-fee reauthorization.
Appropriations: New leadership will influence negotiations over NIH research and funding to implement sudden cardiac arrest prevention programs. Authorizing a program and funding it remain separate steps.
These are leadership expectations, not finalized appointments. HRA will continue working with both parties and with returning and incoming members.
The changes extend well beyond Washington
State elections matter directly to heart rhythm care. State officials shape Medicaid policy, regulation of state-regulated health plans, professional licensing and scope of practice, and requirements for AEDs, CPR training, and emergency action plans.
The National Conference of State Legislatures’ November 4 update reports Democratic flips in the Michigan, Minnesota, North Carolina, and Texas Houses; Pennsylvania Senate; and both chambers in New Hampshire and Wisconsin. Its accessible detailed report continues to flag Arizona’s Senate and Georgia’s House as developing contests. Other trackers and party announcements have moved ahead of that assessment, so this post does not yet treat either as a settled additional flip. Arizona reporting also points to a possible change in its House; that remains a developing result.
The same assessment identifies new Democratic governing trifectas - control of both legislative chambers and the governor’s office - in Michigan, Minnesota, Nevada, Pennsylvania, and Wisconsin. Changes elsewhere produce divided government rather than unified control. Early reporting also shows Republican supermajorities being broken in several states, including Indiana and Ohio. Losing a supermajority does not necessarily mean losing the chamber; it can change the votes needed to override vetoes or take other procedural actions.
For HRA’s regional sections, these changes warrant a fresh look at legislative leadership, health committees, and opportunities for bipartisan state advocacy. A change in party control alone does not establish whether a particular patient-access proposal will advance.
Physicians are winning state office, too
Physician representation is changing at the state level as well:
Ohio: Physician and former state health director Amy Acton (D) won the governorship, bringing a clinical and public health background to a major state executive office.
Hawaii: Physician Josh Green (D) won reelection as governor, preserving an experienced physician voice in state leadership.
Minnesota: Reporting identifies pediatrician Krish Subrahmanian (D) as the winner in state Senate District 49. The Minnesota Medical Association listed him among physicians running for the Legislature this year.
These examples are an initial scan, not a complete national count of physician legislators. HRA will assess opportunities to engage these officials on issues affecting heart rhythm patients and professionals.
What comes next for HRA
HRA will refine its advocacy priorities and activities once the final makeup of Congress and state governments is clear, focusing efforts where we see the strongest opportunities for progress.
That work begins with sustaining momentum in the current Congress, introducing our agenda to incoming policymakers, and rebuilding bipartisan support where champions are departing. In Washington and the states, our approach will remain grounded in clinical evidence and a practical question: what will help patients receive appropriate heart rhythm care when they need it?